King Abdullah Medical City Research Articles

Factors Affecting Implementation of Day of Surgery Admission in King Abdullah Medical City, Makkah

Background: Day of surgery admission, rather than inpatient surgery, is increasingly being considered the norm for all patients undergoing elective surgery, rather than simply an alternative form of treatment for a few. However, it is also important to recognize that the model of provision should be geared to the patient’s needs, since not all patients can be treated on a day-surgery basis. It is necessary to have a system in place for selecting patients carefully, considering surgical, medical (comorbidity) and social criteria. Objective: This study aims to identify the factors affecting implementation of day of surgery admission in hospital. Subjects and Methods: A descriptive cross-sectional design was used to achieve the aim of the study. The population included all the healthcare workers who involved in day of surgery admission process including surgeons, anesthetists, nurses, and administrative staffs in King Abdullah Medical City (KAMC). The researcher made a questionnaire for data collection which included five variables that affect the implementation of day of surgery admission procedures. Data was collected from the participants by using online survey questionnaires. Results: The result shows that all the factors have high mean score which indicate the participants positively agree the statements and when proving the hypothesis, the result appear that there's a solid relationship exist between consider factors and implementation of day of surgery admission. Finally, it was found that some dependent variables have positive correlation with others. Conclusion and Recommendations: it was concluded that the proper implementation of day of surgery admission with the organizational management support can contribute to reduce the waiting time of the patient, cancelation of procedures and all healthcare team will be satisfied. This study recommends the health care leaders to develop a strategic plan to implement day of surgery admission process However, further studies are needed to conduct by including patient’s opinions and as multicenter comparative study to find the effectiveness of day of surgery admission process.

Prevalence of Depression Among Patients With Type 2 Diabetes at King Abdullah Medical City.

IntroductionDiabetes is one of the most common endocrine diseases worldwide. Type 2 diabetes and depression are commonly comorbid, high-prevalence, chronic disorders. Individuals with diabetes mellitus may have concurrent mental health disorders and are shown to have poorer disease outcomes. However, the evidence for clinical correlation is still unclear.ObjectivesTo find the prevalence of depression among patients with type 2 diabetes at King Abdullah Medical City (KAMC).Materials and methodsA cross-sectional observational study was conducted at KAMC in Makkah, the Kingdom of Saudi Arabia. Study participants were 267 people with type 2 diabetes (aged between 18-70 years). Those who had preexisting depression or drank alcohol, pregnant women, and postpartum women were excluded from the study. Participants’ clinical and demographic data and depression assessment were obtained on phone through an interview and using the Arabic version of the Patient Health Questionnaire-9 (PHQ-9), respectively. Glycated hemoglobin (HbA1c) test results of participants were collected electronically.ResultsThe participants’ mean age was 57.88 ± 8.71 years, and 64.4% were males. Only 15.4% were current smokers and 16.9% were ex-smokers. The most common medical condition was hypertension (65.2%) and the majority (92.1%) had uncontrolled HbA1c with a mean value of 8.37 ± 1.92. Among the studied patients, 73% suffered from different degrees of depression; 36%, 19.9%, 8.6%, 5.2%, and 3.4% of the participants were suffering from minimal, mild, moderate, moderately severe, and severe depression, respectively. Only neuropathy was a significant risk factor of depression (odds ratio=2.87, 95% confidence interval=1.18-6.97, p=0.02).ConclusionDepressive symptoms are common in patients with uncontrolled type 2 diabetes who also suffer from neuropathy and retinopathy. Hypertension, cardiovascular diseases, and unhealthy diet had a significant correlation with depression.

Outcomes of Discharged Coronavirus Disease of 2019 Patients from an Emergency Department at a Tertiary Care Hospital: A Pilot Study

Background: Patients with Coronavirus Disease of 2019 (COVID-19) infection can develop varying degrees of illness severity. A critical decision point for all frontline providers affects to whether a given patient is at high risk for severe illness and thus needs inpatient care as opposed to recovery at home. Aim of the study: The aim of the current study is to assess the outcomes of the suspected Covid-19 patients who were swabbed after presenting to the Emergency Department at King Abdullah Medical City and their result came positive for Covid-19. Subjects and Methods: A retrospective pilot study was conducted at KAMC, Holy Makkah-Saudi Arabia. Fifty-one positive covid-19 patients were included at this study. The demographic data, presenting complaint, The Canadian Triage and Acuity Scale (CTAS), comorbidities, discharging vital signs, and hospital revisits were extracted from the electronic medical records (EMR) using Trakcare system. Patients were followed up by phone calls after discharge from the ER for 14 days. Information regarding KAMC hospital revisit or other hospital revisit, quarantine location and length, seeking medical advice, and non-hospital revisit were obtained from the patients or their relatives. Data was collected from15th of March 2020 till 15th of June 2020. Then the outcomes were assessed. Chi-square test and independent sample t-test were used to compare proportions and continuous variables, respectively. The binary logistic regression calculated odds ratios (OR) and 95% confidence intervals (95% CI for the interested predictors. P <0.05 was considered statistically significant. Results: oxygen saturation was found to be the only independent predictor of revisiting COVID 19 patients (OR=0.46; P=0.009). Conclusion: oxygen saturation was found to be the only independent predictor of revisiting COVID 19 patients.

Perspectives of Physicians and Nurses Regarding End-of-Life Care at King Abdullah Medical City in Makkah: A Cross-Sectional Study

Perspectives of Physicians and Nurses Regarding End-of-Life Care at King Abdullah Medical City in Makkah: A Cross-Sectional Study

Efficacy of Pneumatic Retinopexy in Treating Rhegmatogenous Retinal Detachment at King Abdullah Medical City in Makkah, Saudi Arabia - A retrospective cohort study.

The aim of this study was to present the clinical presentation and short-term outcomes of uncomplicated rhegmatogenous retinal detachment managed by pneumatic retinopexy at a tertiary eye hospital in western Saudi Arabia. This one-armed retrospective cohort study evaluated selected cases of rhegmatogenous retinal detachment managed by pneumatic retinopexy between 2017 and 2018. Data were collected on patient demographics, preoperative ophthalmic assessment, surgical details, follow up at six months postoperatively, complications and the need for additional surgery. Anatomic success was defined as retinal attachment at 6 months and functional success was defined as vision >20/200 at six months postoperatively. The association of lens status and concomitant laser treatment to anatomical success rates were evaluated. The study sample consisted of 15 eyes with rhegmatogenous retinal detachment in the upper quadrant. In 14 cases, C3F8 gas was used. Anatomic and functional success was noted in 73.3% [95% confidence interval (CI) 51.0: 95.7] and 86.7% (95% CI 69.2; 100) of eyes, respectively. The association between anatomical success and lens status was not significant [RR = 4.5 (95% CI 0.6 ; 37.5), P=0.1]. There was no significant association between anatomical success and concomitant laser treatment. [RR = RR = 1.7 (95% CI 0.7 ; 4.0), P=0.2]. A 2nd retinal surgery was not required in 33.3% of eyes (95% CI 9.5 ; 57.2). If stringent selection criteria are used for managing rhegmatogenous retinal detachment with pneumatic retinopexy, anatomical and functional success by six months postoperatively is achieved in the majority of cases. Additional surgeries could further improve outcomes.

Strategies to Offer Uninterrupted Neurosurgical Care at a Tertiary Center in Makka amid COVID-19 Pandemic.

Background:Globally, there is a shooting pandemic that affected many healthcare systems. Healthcare facilities had to set up logistics to avoid being drained while facing a catastrophic health problem. There are currently no available vaccines or perfect therapies and also no certified immunity against that disease. Therefore, it is probable that healthcare systems will face it for an exceptionally long period. That will have a grave effect on the strategy of daily practice of different specialties' services at healthcare centers. Impossible decisions in usual workdays are now forcibly adopted for the sake of patients, care providers, and health resources.Methods:We try in a simple way to share tertiary center expertise in managing neurosurgical cases amid a dreadful healthcare crisis. Healthcare workers' safety and patient safety were typical priorities for neurosurgical service at King Abdullah Medical City. We expose the lines of management, triaging cases, the methods of handling confirmed and suspected neurosurgical patients, and strategies for discharging and following up patients. We identified hospital admission and discharge records starting from March 2020 till July to track the neurosurgical case burden and the state of service offered and the rate of infection among healthcare workers who participated in surgeries.Results:At the peak time of the COVID-19 pandemic in Makka starting from March till July, we have admitted 250 neurosurgical patients. About 210 (84%) of them did surgeries according to the triaging protocol described in the article. About 155 (62%) of those who did surgeries were urgent and the rest were borderline or semi-urgent. About 10 (4%) were severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and three of them died due to acute respiratory distress syndrome. Only two mortality cases were reported due to a neurological complication and not related to SARS-CoV-2 infection. The rest of the cases (98%) were discharged for follow-up without grave complications after they were offered the service. No neurosurgeons or anesthesia staff involved in offering the service were infected with SARS-CoV-2. Successful uninterrupted neurosurgical care was available for patients during that health crisis without any healthcare worker being infected.Conclusion:Following the suggested strategies, any center can provide the healthcare service amid any pandemic happening now or in the future without dismantling the normal health system, especially for life-saving cases in a critical specialty as neurosurgery.

Impact of COVID-19 on the rate of stroke cases at a tertiary hospital in Makkah, Saudi Arabia.

ABSTRACTObjectives:To assess and quantify the impact COVID-19 has had thus far on ischemic stroke admission rate and severity (National Institutes of Health Stroke Scale (NIHSS) score) at a single tertiary center in Makkah, Saudi Arabia.Methods:This is a retrospective analysis performed on admitted cases with definitive final diagnoses of transient ischemic attack (TIA) and ischemic stroke at King Abdullah Medical City in Makkah between January 1, 2020 and July 2020.Results:Sixty-nine patients were included in our study, 41 of whom presented at our facility before the pandemic and 29 during the pandemic. No statistical significance was observed between rate of admission, stroke severity, and rate of thrombolysis before the COVID-19 pandemic and after the outbreak. We observed a reduction of mean arrival time after the pandemic began, as well as a reduction of hospital stay days.Conclusion:A 29% reduction of admission secondary to acute ischemic stroke was noted during the pandemic. However, COVID-19 did not affect acute stroke care at our institute. The study is limited because of its small sample size, as we assessed just one medical center.

Factors Affecting the Main Operation Room Utilization Time at King Abdullah Medical City

Background: Hospitals and operating room departments aim to improve quality and safety, as well as utilization and efficiency. Operating rooms are cost-intensive, multi professional parts of health care organizations. Thus, efficient usage of OR capacity is crucial. Aim of the study: The aim of the current study is to determine the factors affecting the main operation room utilization time at King Abdullah Medical City (KAMC). Subjects and Methods: A retrospective descriptive research design was utilized to achieve the aim of the study. Four hundred forty-eight days included in this study with no missing data. Data was collected from the operations registration office and the quality department at KAMC in Saudi Arabia in terms of data inventory and reliability and was analyzed by statistical package for social sciences (SPSS) version 24. Results: 94.2% of ICU beds post-operative were available. Also, 77.9 % of surgeon' attendance on time and 75.5% of the first cases started on time. Highly statistical significant difference between 2017 and 2018 in relation to predictor factors of operation room utilization time was found. Conclusion: Availability of intensive care unit beds, starting the first case start on time and surgeon' attendance on time are the predictor factors for operating room utilization time. Recommendations: Ministry of health should work as much as possible to provide enough intensive care beds for operation theatre. Also, surgeons should attend to work at operation room at the right time and they should start working with the first case at the right time. The staff should be motivated by different incentives to start the operation on time.

Comparing Accuracy of Manual Triage with Electronic Triage System

BACKGROUND: Triage is the process of sorting patients in the emergency department (ED) based on the severity of their clinical presentation. There are several protocols to categorize patients and provide order in which and where a patient will be seen in the ED. It is a useful tool for organization and managing resources in the ED. OBJECTIVE: This research aims to compare the accuracy and applicability of the electronic Canadian Triage and Acuity Scale (CTAS) to the manual CTAS system. DESIGN: It is a descriptive, analytical prospective study that was conducted in King Abdullah Medical City (KAMC), Makkah, Saudi Arabia. SUBJECTS AND METHODS: During the study period, 389 patients were triaged with both manual and electronic CTAS triaging systems. RESULTS: Our research shows a low strength of agreement between manual and electronic triaging systems. The scores differ significantly that we cannot interpret the accuracy between the two systems. Additionally, our study shows that the predominant triaging score was CTAS 3 in both electronic and manual triaging systems and this could reflect the higher acuity of patient presentations to KAMC ED. KAMC is a specialized tertiary care center where patients frequently require a higher level of care. CONCLUSION: Our research demonstrates the potentials of improving the triage process in the ED. Furthermore, this research highlighted the higher acuity of patients presented to KAMC ED and we believe this can give insight and further guidance for staffing, type, and the number of beds needed for our ED. However, further studies are needed to compare the electronic versus the manual triaging systems regarding the time required for completing the triage, impact of bed occupancy at the time of triage, as well as the number of staff available.

Factors Influence Compliance to Medication Reconciliation Process in King Abdullah Medical City

Medication reconciliation has been recognized as an important National Patient Safety Goal by the Joint Commission. Studies have shown that hospitals with medication reconciliation Programs led by pharmacists, as part of the interdisciplinary team, may have improved outcomes in the following areas of assessment: the rates of medication errors, adverse events, and readmissions. This study aims to investigate the factors that influence the compliance to the medication reconciliation process. It is a quantitative analytical Cross-Sectional design undertaken at the specialized hospital, Makkah, Saudi Arabia. The study adopted the following independent variables (knowledge and training about medication reconciliation, Medication reconciliation policy, procedures involved in the medication reconciliation process, and organizational support) and the compliance to the medication reconciliation process in KAMC as dependent variables. Data collected from 90 pharmacists by using a self-administered questionnaire. When proving the hypothesis, the result showed that there is a positive correlation between the study variables including knowledge and training, medication reconciliation policy and procedures, and organizational management support with the compliance of medication reconciliation process. This study concluded that hospital pharmacists should be knowledgeable and have adequate training about medication reconciliation process. Proper implementations of policy and procedures with the organizational management support can contribute to improving the medication reconciliation process. However, further studies are needed to include all physicians and nurses to determine overall institutional factors that influence medication reconciliation process improvement.

The Impact of Upgrade towards Comprehensive Electronic Medical Record System on Hospital Performance: A Single Tertiary Care Center Experience in Saudi Arabia

In line with the global trend, hospitals in the Kingdom of Saudi Arabia, including tertiary medical care centers, have increasingly adopted comprehensive electronic medical record (EMR) systems in the past twenty years. However, knowledge of these systems and the extent of their impact on performance is still limited in the Kingdom due to the lack of studies researching in this field. Accordingly, this study aims to investigate the impact of implementing a comprehensive EMR system in King Abdullah Medical City (KAMC) on hospital performance and to test the assumed hypotheses which propose that implementing a comprehensive EMR significantly improves the clinical effectiveness, patient-centeredness, patients’ safety and production efficiency in an advanced tertiary care setting in Saudi Arabia. To achieve this, a quantitative cross-sectional survey was conducted, using a valid questionnaire, on a random representative sample of 150 participants from healthcare professionals working in KAMC who experienced the upgrade towards the comprehensive EMR. The data collected was analyzed and the results showed the existence of statistically significant relationships between the implementation of comprehensive EMR as an independent variable and the four investigated dependent variables which are clinical effectiveness, patient-centeredness, patients’ safety and production efficiency in an advanced tertiary care setting in Saudi Arabia at significance level p=0.000 < 0.05. The study concluded the necessity of implementing comprehensive EMR to the point where tertiary care hospitals should pay attention to the application of such advanced electronic system because of their role in improving health care performance. Eventually, the study recommends the need to build an integrated EMR system at the level of the Kingdom that ensures the safe exchange of information between hospitals and health national centers which would enhance the provision of more distinguished health service for each patient, increase administrative efficiency and reduce the use of traditional means of recording like paper.

Evaluation the Door-to-Balloon Time in Patient with STElevation Myocardial Infraction (STEMI) in King Abdullah Medical City (KAMC) in Makkah Almukarramah: A Retrospective Single Center Study

Background: ST-Elevation Myocardial Infarctionis a time-sensitive emergency condition. Thus, guidelinesrecommended 90 minutes or less for door-to-balloon time at a percutaneous coronary intervention-capablehospital and with in 120 minutes or less if transferred from per cutaneous coronary intervention-UncapableHospital. The main objective was to evaluate the recommended time needed forreperfusion therapyparticularly percutaneous coronary intervention inpatients with ST-Elevation Myocardial Infarctionat KingAbdullah Medical City.Method and Results: A retrospective single center study. Data were obtained from 47 patients recordsdiagnosed with ST-Elevation Myocardial Infarction and treated with percutaneous coronary interventionatKing Abdullah Medical Cityfrom Jan 2018 through March 2019. About 36.4% of patients receivedpercutaneous coronary intervention in more than 90 Minutes eventhough they arrived directly at KingAbdullah Medical City. For patients who were transferred to King Abdullah Medical City, 63.9% of thosepatients did not achieve the recommended door-to-balloon time.Conclusion: High percentage of patients with ST-Elevation Myocardial Infarctionat King Abdullah MedicalCity did notreceive percutaneous coronary intervention within the recommended timeline.

Management of Vocal Complications Post Thyroidectomy at King Abdullah Medical City from 2011 to 2018

Background: The most common critical complication after thyroidectomy is vocal cord dysfunction. The leading cause of that problem is injury to the recurrent laryngeal nerve (RLN). Materials and Methods: A retrospective cohort study was applied to 266 patients who underwent thyroidectomy procedures at King Abdullah Medical City between the years of 2011 and 2018. Patients with preexisting vocal cord abnormalities and neurological conditions affecting the voice or swallowing ability were excluded. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics V21.0). Results: Out of the 266 patients, the incidence of RLN injury was significantly higher if the patient had a previous thyroid surgery, especially among cancer patients (30.4% in cancer vs. 9.2% in noncancer, P = 0.001). Patients who presented with postoperative vocal complications were only five; four of them developed temporary unilateral vocal cord palsy (1.6%) and were managed with speech therapy, however, one patient had a permanent bilateral vocal cord palsy (0.4%) that was managed with tracheostomy and laser vocal cordotomy. Conclusion: The incidence of vocal cord complication due to thyroidectomies was comparatively rare. Thyroid complications were present more in cancer patients.

The prevalence of obesity in hospitalized COVID-19 patients at King Abdullah Medical City, Makkah, Saudi Arabia

The prevalence of obesity in hospitalized COVID-19 patients at King Abdullah Medical City, Makkah, Saudi Arabia

The Impact of Short-Term Solutions of Nursing Shortage on Nursing Outcome, Nurse Perceived Quality of Care, and Patient Safety

BACKGROUND: Nurses represent a significant proportion of the entire healthcare workforce. Unfortunately, the world is plagued with the shortage of qualified nurses to deliver safe, dignified, compassionate care. OBJECTIVE: The objective of the study was to determine the relationships between overtime and floating as short-term solutions and nursing outcomes, nurse-perceived quality of care and patient safety among registered nurses in Saudi Arabia. SETTING/DESIGN: A cross-sectional study was conducted at King Abdullah Medical City (KAMC) located in Makkah, Saudi Arabia. SUBJECTS AND METHODS: The study was conducted for two months (from July 20, 2020 to August 20, 2020), including both inpatient and outpatient registered nurses who had worked for, at least, one year at KAMC either as part-time or full-time. Nurses who had worked for less than one year, nurse educators, nurse managers and clinical nurse specialists were excluded. Measuring Variables included demographic characteristics, job satisfaction, intention to leave, nursing perceived quality of care, perceived patient safety, patient safety, patient acuity and dependency, workload and floating. A pre-designed questionnaire was distributed to willing nurses. Data were non-normally distributed and Scatter plots were also generated. T-test was used to find the relation of floating and overtime with sample characteristics. RESULTS: A total of 337 registered nurses completed the questionnaire. Majority of the participants were from 41-50 years of age group (60.5%), and non-Saudi nationals (90.5%). Statistically significant relation of age groups with development of pressure ulcers (p = 0.030) was found. Nationality showed significant relation with job satisfaction (p = 0.008), quality of care (p = 0.006) and patient safety (p <0.05). Specialist nursing category showed significant association with quality of care (p = 0.008) and pressure ulcers development (p = 0.050). Education level, overtime floating showed significant association with intention to leave (p <0.05). Nationality, extended shifts and mandatory overtime had significant association with job satisfaction. Hospital data showed significant association of overtime with medication error. CONCLUSION: Unmarried Saudi nurses have potential to provide quality of care to the patient with satisfied patient safety, especially in the days of overtime and increased workload.

The Effect of Central Venous Catheter Maintenance Bundle Implementation on Central Line Associated Infection Rate in the Intensive Care Unit

Background: Central venous catheters (CVC) play an important role in the treatment of hospitalized critically ill patients. To improve patient outcome and to reduce healthcare costs, there is considerable interest by healthcare providers in reducing the incidence of Central line associated blood stream infections. OBJECTIVE: This study aims to evaluate the efficacy of the implementation of CVC bundle to all patient admitted in intensive care unit with central line on the reduction of the rate of central line associated blood stream infection. SETTINGS/DESIGN: Quasi-experimental before and after study design conducted in intensive care unit of King Abdullah Medical City, Makkah. SUBJECTS AND METHODS: This study was targeting all patient with central line in intensive care unit. At the time of central line insertion bundle was initiated and maintained until the removal of central line over 12 months period started on December-2018 and ended on December-2019. RESULTS: Study result show a significant reduction (77%) of CLABSI rates, before and after CVC maintenance bundle implementation, which show the effectiveness of bundle implementation on ICU patient and also there is improvement in site selection, subclavian site selection has been increases to 27% during post bundle period compare to 9.5% before pre bundle period, so this improvement may have some impact on the result of CLABSI. Despite study intervention there was slight improvement in insertion bundle compliance rate increase from 89% to 96% over twelve months during study period. CONCLUSION: The study found the effectiveness of central line bundle implementation on ICU patient; this result been achieved with presence of high compliance to the element of bundle by ICU nurses. Looking to CLABSI cases before and after bundle implementation, variable which been observed were close to each other.

Thirty-Day Mortality After Curative and Palliative Anti-Cancer Treatment: Data Interpretation and Lessons for Clinical Implementation.

PurposeDespite advancements in cancer therapeutics, mortality and morbidity due to anti-cancer treatments still occur but are not frequently reported. We aimed to report the 30-day mortality and morbidity of all curative and palliative anti-cancer treatments.Patients and MethodsAdults with solid and hematological malignancies from two large cancer centers in Saudi Arabia, irrespective of the cancer stage and treatment type, were included in this retrospective observational study.ResultsBetween December 1, 2019 and February 29, 2020, 1694 patients from King Abdullah Medical City in Makkah and King Fahad Medical City in Riyadh were included in the study. Among them, 77.5% were younger than 65 years of age; 72.8% were female; the prevalence of obesity, diabetes, and hypertension was 35%, 34%, and 28%, respectively; and 66.5% of patients had breast and gastrointestinal cancers. Fifty-nine (3.5%) patients died within 30 days of receiving anti-cancer treatment. Of them, 9 (0.3%) were treated with curative intent, and 50 (3%) were treated with palliative intent.ConclusionOur results emphasize the need to address preventable metabolic changes and implement innovative, predictive, preventive, and personalized medicine (PPPM) approaches focusing on patient profiles. Reporting the 30-day outcomes of all anti-cancer treatments will also allow the identification of factors underlying mortality and morbidity and lead to an improvement in oncological outcomes via innovative programs designed to improve clinical decision-making.

Role of fine-needle aspiration cytology in evaluating thyroid nodules. A retrospective study from a tertiary care center of Western region, Saudi Arabia.

Objectives:To evaluate the accuracy and efficacy of fine-needle aspiration cytology (FNAC) in diagnosing thyroid nodules, correlating it with the histopathological findings.Methods:A retrospective evaluation of 314 patients was undertaken at a tertiary referral center of King Abdullah Medical City (KAMC), Makkah, Kingdom of Saudi Arabia, between 2010-2019. Patients who presented with thyroid swellings underwent ultrasonography and FNAC. If indicated, surgery was performed. The FNAC findings were compared to the final histopathological reports.Results:The findings for FNAC from our data set of 314 patients showed a sensitivity value of 79.8%, specificity of 82.1%, accuracy of 74.8%, positive predictive value of 74.8%, and negative predictive value of 85.9%.Conclusion:Our study showed that FNAC has high sensitivity and specificity in the initial evaluation of patients with thyroid nodules. When guided by ultrasonography, the accuracy can be markedly improved. Molecular markers once widely available can improve the diagnostic power of FNAC to be no less than the histopathologic evaluation of thyroid tissue.

Incidence, risk factors, clinical presentation, and outcomes of hemorrhagic transformation in patients with ischemic stroke admitted to a tertiary hospital in Kingdom of Saudi Arabia.

Objectives:To describe the incidence rate, clinical presentation, relevant risk factors, and outcome of hemorrhagic transformation (HT) among ischemic stroke patients.Methods:This retrospective study analyzed HT in patients with ischemic stroke admitted to King Abdullah Medical City from August 2011 to April 2019. Data were analyzed using SPSS. Patients characteristics, procedures, treatments, and outcomes were reported.Results:There were 504 ischemic stroke patients. The HT was detected in 38 patients (8%). The median age was 66.5 (54.3 -77.5) years, and 24 (63%) were males. HT was classified as hemorrhagic infarction (HI) in 22 patients (58%) while 16 patients (42%) were parenchymal hematoma (PH). The most common risk factors noted were: hypertension (74%), diabetes mellitus (DM) (66%), hyperlipidemia (63%) and ischemic heart disease (IHD) (61%). Nine patients (23.6%) developed HT after receiving thrombolytic therapy. Only one patient (3%) died of HT patients.Conclusion:HT accounted for (8%) of all ischemic stroke patients. Old age, DM, hypertension, and hyperlipidemia are frequently encountered with stroke patients who developed HT. Follow up CT brain could be of value and could identify HT early to get better outcomes.

71. Factors predicting hospital admission for non-urgent patients triaged with the Canadian Triage and Acuity Scale (CTAS) in the Emergency Department. a retrospective study in Tertiary Center in Makkah, KSA.

Background: Triage system is prioritizing patients according to their urgency to deal with overcrowding of non-urgent patients in the Emergency Department (ED). The aim of this study is to evaluate the admission of non-urgent patients in order to decrease the burden on the ED by triaging them away to the Primary Health Care (PHC). Design and Methods: This retrospective cohort study included all adult non-trauma ED visits in King Abdullah Medical City (KAMC), triaged as Canadian Triage and Acuity Scale (CTAS) IV and V, from May 9 to July 8, 2019. The data was extracted from KAMC database onto SPSS. Multivariate logistic regression was used to examine which factors could affect admission. Results: CTAS IV and CTAS V patients were 30.31% (1495/5066) of total ED visits. Admission was 6.02%; 5.8% for CTAS IV and 0.2% for CTAS V. All CTAS V admissions were elective. Nausea and vomiting (14.4%) were the most frequent chief complaints in the admitted group. The overall referral of non-urgent patients was 12.4% and bounce-back was 13.7%. Logistic regression showed that being tachypneic (OR: 6.68; 95%CI: 1.4-31.5), hypertensive (OR: 3.4; 95%CI: 2.2-5.4) or an oncology patient (OR: 2.85; 95%CI: 1.8-4.6) predicted hospital admission. Conclusion: All CTAS V cases can be safely triaged away to the PHC; CTAS IV can be either triaged away to PHC or to urgent care center, taking into consideration whether the patient is tachypneic, hypertensive or an oncology patient.